Geriatric Medicine Flashcards
Acute confusional state is also known as delirium or acute organic brain syndrome. What are the risk factors for developing it?
age > 65 years
background of dementia
significant injury e.g. hip fracture
frailty or multimorbidity
polypharmacy
What are the main causes of delirium?
change of environment
infection: particularly UTIs
metabolic: e.g. hypercalcaemia, hypo/hyperglycaemia, dehydration
severe pain
alcohol withdrawal
constipation- consider constipating medications e.g. codeine and ondansetron
How is delirium managed?
Tx underlying cause, modify environment, try haloperidol
(unless pt has Parkinsonism)
What is involved in a ‘confusion screen’ bloods and why?
B12/folate: macrocytic anaemias, B12/folate deficiency worsen confusion
TFTs: confusion is more commonly seen in hypothyroidism
Glucose: hypoglycaemia can commonly cause confusion
Bone Profile (Calcium): hypercalcaemia can cause confusion
Outline the pharmacological management of Alzheimer’s disease
1st line for mild - moderate disease : donepezil, galantamine and rivastigmine (all ACh inhibitors)
2nd line for severe disease / where 1st line is contraindicated: memantine (an NMDA receptor antagonist)
Alzheimer’s disease causes widespread cerebral atrophy mainly involving…
the cortex and hippocampus
What factors favour delirium over dementia as a diagnosis?
impairment of consciousness
fluctuation of symptoms: worse at night, periods of normality
abnormal perception (e.g. hallucinations and delusions)
agitation, fear
Why is a blood screen done in new suspected dementia?
To look for reversible causes
How does Lewy-Body dementia typically present?
Dementia, visual or auditory hallucinations, delusions and Parkinsonism
Fluctuating cognition
Give some risk factors for multi-morbidity
increasing age
Female sex
Low socioeconomic status
Tobacco and alcohol usage
Lack of physical activity
Poor nutrition and obesity
What is the most common comorbid condition?
Hypertension
Define fraility.
How should it be assessed?
Frailty is defined as a state of impaired homeostasis leading to increased vulnerability to minor stressor events.
through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire
What is the GPCOG test?
a test designed as a GP screening tool for dementia
What is the Waterlow score?
Used to identify patients at risk of pressure sores
What is the clinical frailty scale? How is it helpful?
Set of 9 phenotypes ranging from very fit to terminally ill which can be used to summarise the older patient’s overall level of fitness or frailty and predict outcomes of survival/prognosticate
What is a CGA?
comprehensive geriatric assessment —> Multidimensional, interdisciplinary diagnostic processes to determine the medical, psychological and functional capabilities of frail older people to develop a coordinated & integrated plan for treatment and long-term follow up
What are the “geriatric giants”?
Immobility
Instability/falls
Incontinence
Impaired memory (dementia, delirium)
Iatrogenesis
What are the domains of a CGA? (7)
o Problem list – current and past
o Medication review
o Nutritional status
o Mental health – cognition, mood and anxiety, fears
o Functional capacity - basic activities of daily living , gait and balance, exercise status
o Social circumstances
o Environment - home environment, facilities and safety within the home, accessibility to local resources
What are the complications associated with delirium?
increased mortality, prolonged hospital admission, higher complication rates, institutionalisation and increased risk of developing dementia
How can delirium be categorised?
hyperactive (agitated and confused), hypoactive
(withdrawn and drowsy) or mixed.
Faecal incontinence in the elderly is always abnormal and usually curable. What is it most commonly caused by?
faecal impaction with overflow diarrhoea. This accounts for 50% of faecal incontinence. The second most common cause is neurogenic dysfunction
Which tool is used to assess the risk of stroke in the short term post TIA?
The ABCD2 score
The ABCD2 score is calculated by summing up the points for five different factors including age, blood pressure, clinical features, duration of symptoms and the presence of diabetes. ABCD2>=4 indicates a higher risk.
Give some indications that a patient is reaching the end of life
o Bed bound.
o Semi-comatose.
o Only able to take sips of fluid.
o Unable to take medicine orally
Alzheimer’s disease is the most common cause of dementia. How does it present?
Insidious onset with slow progression. Behavioural problems are common. Diagnosed on clinical history but brain imaging may show disproportionate hippocampal atrophy.
